Upselling in Medicine: Would You Like a Pap Smear with that Ankle Brace, Ma’am?

For many years, I’ve held a brief huddle with my team every morning to make sure we are ready for the day: Anybody with complex problems coming in today? Anybody who’s been in the ER? How is Mrs. Jones’ husband over at the nursing home, is she worried about his condition? Where can we squeeze in more add-on’s?

Now other people have tried to hijack the word “huddle” for a completely different purpose. They want to use it to slow us down instead of helping get us get through the avalanche of issues we’re already expecting. In my other office they call it pre-visit planning. It’s not about having the MRI result available or the recent ER note, but more about who is behind on some aspect of their health maintenance and (unsuspectingly) expecting just a sore throat visit, but consistently avoiding their diabetes followup visits?

My veterinarian colleagues handle this differently. They just send a post card at random times, or hand me a paper, usually part of my exit statement, as I recall, that says which critter is due for what. But in that case I’m already safely close to the door and nobody is expecting me to act on it in that instant.

In human medicine, our quality ratings, and soon our paycheck, will depend on how effectively we convince patients to get caught up on their proscribed health maintenance.

In the retail world, they call that upselling. When I stop at a 24 hour gas station and buy some coffee for my long trip between my two offices, they always ask if I want some donuts or chips with that, maybe a banana or whatever. Same thing at the hardware store, if I buy a flashlight, they ask if I need spare batteries, and so on.

How fair is that to our patients?

I remember seeing a video about the hijacked kind of huddle, where the doctor and medical assistant almost gleefully talk about how to convince a noncompliant female patient to have her overdue Pap smear when she is only expecting something much less involved.

And all the while we are supposed to be patient centered and respect each patient’s own agenda. Too bad not everyone else has to…

3 Responses to “Upselling in Medicine: Would You Like a Pap Smear with that Ankle Brace, Ma’am?”

For those of us who work in capitated HMO settings, it’s not really “up selling” (which implies that one is profiting, ie, making money, from providing an additional service) but actually adding to the work the provider is expected to try to do at the visit (and get further behind and drop in Press Ganey scores).
I agree it ought to be what the patient is there for and wants, but “He who pays the piper calls the tune.”

Yep, upselling tests and over-diagnosing non-problems, the main reasons I rarely visit my primary care provider. If I go in for something minor and acute, I want that treated without a guilt trip or some surprise test unrelated to my current need.

I can’t tell you how refreshing your blog is. I’ve been reading it for a several years and look forward to every post. Thanks.